title: A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.
abstract: OBJECTIVE
  Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult.
  
  
  METHODS
  Before-and-after trial.
  
  
  METHODS
  Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan.
  
  
  METHODS
  We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution.
  
  
  RESULTS
  With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study.
  
  
  CONCLUSIONS
  Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.
authors.affiliation: Department of Infection Prevention, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Honda
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sato
authors.forename: Akinori
authors.initials: A
authors.lastname: Yamazaki
authors.forename: Simi
authors.initials: S
authors.lastname: Padival
authors.forename: Akira
authors.initials: A
authors.lastname: Kumagai
authors.forename: Hilary
authors.initials: H
authors.lastname: Babcock
mesh_terms: D006293:Health Promotion / Q000379:methods*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D007564:Japan; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers; D014611:Vaccination / Q000379:methods* / Q000706:statistics & numerical data